Current through Register Vol. 39, No. 6, September 16, 2024
(a) The
discharge of a resident initiated by the facility shall be according to
conditions and procedures specified in Paragraphs (a) through (j) of this Rule.
The discharge of a resident initiated by the facility involves the termination
of residency by the facility resulting in the resident's move to another
location and the facility not holding the bed for the resident based on the
facility's bed hold policy.
(b) The
discharge of a resident initiated by the facility at the direction of the
administrator or their designee shall be based on one of the following reasons:
(1) the discharge is necessary to protect the
welfare of the resident and the facility cannot meet the needs of the resident,
as documented by the resident's physician, physician assistant, or nurse
practitioner in the resident's record;
(2) the health of the resident has improved
sufficiently so that the resident is no longer in need of the services provided
by the facility, as documented by the resident's physician, physician
assistant, or nurse practitioner in the resident's record;
(3) the safety of the resident or other
individuals in the facility is endangered as determined by the facility at the
direction of the administrator or their designee in consultation with the
resident's physician, physician assistant, or nurse practitioner;
(4) the health of the resident or other
individuals in the facility is endangered as documented by a physician,
physician assistant, or nurse practitioner in the resident's record;
or
(5) the resident has failed to
pay the costs of services and accommodations by the payment due date according
to the resident's contract after receiving written notice of warning of
discharge for failure to pay.
(c) The facility administrator or their
designee, shall assure the following requirements for written notice are met
before discharging a resident:
(1) The Adult
Care Home Notice of Discharge with the Adult Care Home Hearing Request Form
shall be completed and hand delivered, with receipt requested, to the resident
on the same day the Adult Care Home Notice of Discharge is dated. These forms
may be obtained at no cost from the Division of Health Benefits, on the
internet website
https://policies.ncdhhs.gov/divisional/health-benefits-nc-medicaid/forms.
The Adult Care Home Notice of Discharge shall include the following:
(A) the date of notice;
(B) the date of transfer or
discharge;
(C) the reason for the
notice;
(D) the name of responsible
person or contact person notified;
(E) the planned discharge location;
(F) the appeal rights;
(G) the contact information for the long term
care ombudsman; and
(H) the
signature and date of the administrator.
(2) A copy of the completed Adult Care Home
Notice of Discharge and Adult Care Home Hearing Request Form shall be hand
delivered, with receipt requested, or sent by certified mail to the resident's
responsible person or legal representative and the individual identified upon
admission to receive a discharge notice on behalf of the resident on the same
day the Adult Care Home Notice of Discharge is dated. For the purposes of this
Rule "responsible person" means a person chosen by the resident to act on their
behalf to support the resident in decision-making; access to medical, social,
or other personal information of the resident; manage financial matters; or
receive notifications. The Adult Care Home Hearing Request Form shall include
the following:
(A) the name of the
resident;
(B) the name of the
facility;
(C) the date of transfer
or discharge;
(D) the date of
scheduled transfer or discharge;
(E) the selection of how the hearing is to be
conducted;
(F) the name of the
person requesting the hearing; and
(G) for the person requesting the hearing,
their relationship to the resident, address, telephone number, their signature,
and date of the request.
(3) Provide the following material in
accordance with the Health Insurance Portability and Accountability Act of 1996
(HIPAA) to the resident and the resident's legal representative and the
individual identified upon admission to receive a copy the discharge notice on
behalf of the resident:
(A) a copy of the
resident's most current FL-2 form required in Rule .0703 of this
Subchapter;
(B) a copy of the
resident's current physician's orders, including medication order;
(4) Failure to use and
simultaneously provide the specific forms according to Subparagraphs (c)(1) and
(c)(2) of this Rule shall invalidate the discharge.
(5) A copy of the completed Adult Care Home
Notice of Discharge, the Adult Care Home Hearing Request Form as completed by
the facility administrator or their designee prior to giving to the resident
and a copy of the receipt of hand delivery or the notification of certified
mail delivery shall be maintained in the resident's record.
(d) The notices of discharge and
appeal rights as required in Paragraph (c) of this Rule shall be made by the
facility administrator or their designee, at least 30 days before the resident
is discharged except that notices may be made as soon as practicable when:
(1) the discharge is necessary to protect the
welfare of the resident and the facility cannot meet the needs of the resident
under Subparagraph (b)(1) of this Rule; or
(2) reasons under Subparagraphs (b)(3) and
(b)(4) of this Rule exist.
(e) The following shall be documented in the
resident record and shall be made available upon request to potential discharge
locations pursuant to the HIPAA Standards for Privacy of Individually
Identifiable Health Information which is hereby incorporated by reference,
including any amendments and subsequent editions, and can be found at no cost
at
https://www.federalregister.gov/documents/2002/08/14/02-20554/standards-for-privacy-of-individually-identifiable-health-information:
(1) The reason for discharge to include one
or more of the following as applicable to the reasons under Paragraph (b) of
this Rule:
(A) documentation by physician,
physician assistant or nurse practitioner as required in Paragraph (b) of this
Rule;
(B) the condition or
circumstance that endangers the health or safety of the resident being
discharged or endangers the health or safety of individuals in the facility,
and the facility's taken to address the problem prior to pursuing discharge of
the resident;
(C) written notices
of warning of discharge for failure to pay the costs of services and
accommodations; or
(D) the specific
health need or condition of the resident that the facility determined could not
be met in the facility pursuant to
G.S.
131D-2.2(a)(4) and as
disclosed in the resident contract signed upon the resident's admission to the
facility; and
(2) any
known involvement of law enforcement with the resident due to threatening
behavior or violence toward self or others.
(f) The facility administrator or their
designee shall document contacts with possible discharge locations and
responses and make available this documentation, upon request, to the resident,
legal representative, the individual identified upon admission to receive a
discharge notice on behalf of the resident and the adult care home resident
discharge team if convened. For the purposes of this Rule, "the individual
identified upon admission to receive a discharge notice on behalf of the
resident" may be the same person as the resident's legal representative or
responsible person as identified in the resident's record.
(g) The facility administrator or their
designee shall provide sufficient preparation and orientation to residents to
ensure a safe and orderly discharge from the facility as evidenced by:
(1) explaining to the resident and
responsible person or legal representative and the individual identified upon
admission to receive a copy of the discharge notice on behalf of the resident
why the discharge is necessary;
(2)
informing the resident and responsible person or legal representative and the
individual identified upon admission to receive a copy of the discharge notice
on behalf of the resident about an appropriate discharge destination that is
capable of meeting the needs of the resident; and
(A) If at the time of the discharge notice
the discharge destination is unknown or is not capable of meeting the needs of
the resident, the facility administrator or their designee, shall contact the
local adult care home resident discharge team as defined in
G.S.
131D-4.8(e) to assist with
placement; and
(B) The facility, at
the direction of the administrator or their designee, shall inform the
resident, the resident's legal representative, the individual identified upon
admission to receive a copy of the discharge notice on behalf of the resident,
and the responsible person of their right to request the Regional Long-Term
Care Ombudsman to serve as a member of the adult care home resident discharge
team; and
(3) offering
the following material to the resident, the resident's legal representative, or
the facility where the resident is to be placed and providing this material as
requested prior to or upon discharge of the resident:
(A) a copy of the resident's most current
FL-2 form required in Rule .0703 of this Subchapter;
(B) a copy of the resident's most current
assessment and care plan;
(C) a
list of referrals to licensed health professionals, including mental
health;
(D) a copy of the
resident's current physician orders;
(E) a list of the resident's current
medications;
(F) the resident's
current medications; and
(G) a
record of the resident's vaccinations and TB screening;
(4) providing written notice of the name,
address and telephone number of the following, if not provided on the discharge
notice required in Paragraph (c) of this Rule:
(A) the regional long-term care ombudsman;
and
(B) Disability Rights North
Carolina, the protection and advocacy agency established under federal law for
persons with disabilities.
(5) providing the resident, responsible
person, or legal representative, and the individual identified upon admission
who received a copy of the discharge notice on behalf of the resident with the
discharge location as determined by the adult care home resident discharge
team, if convened, at or before the discharge hearing, if the location is known
to the facility.
(h) If
an appeal hearing is requested:
(1) the
facility administrator or their designee shall provide to the resident or legal
representative or the resident and the responsible person, the Hearing Unit
copies of all documents and records that the facility intends to use at the
hearing at least five working days prior to the scheduled hearing;
and
(2) the facility administrator
or their designee shall not discharge the resident before the final decision
resulting from the appeal has been rendered, except in those cases of discharge
specified in Paragraph (d) of this Rule.
(i) If a discharge is initiated by the
resident, the resident's legal representative, or responsible person, the
administrator may require up to a 14-day written notice from the resident, the
resident's legal representative, or responsible person which means the resident
may be charged for the days of the required notice if notice is not given or if
notice is given and the resident leaves before the end of the required notice
period. Exceptions to the required notice are cases in which a delay in
discharge or transfer would jeopardize the health or safety of the resident or
others in the facility. The facility's requirement for a notice from the
resident, the resident's legal representative, or responsible person shall be
established in the resident contract provided to the resident or responsible
person upon admission.
(j) The
discharge requirements in this Rule do not apply when a resident is transferred
to an acute inpatient facility for mental or physical health evaluation or
treatment and the adult care facility's bed hold policy applies based on the
expected return of the resident. If the facility administrator or their
designee decides to discharge a resident who has been transferred to an acute
inpatient facility and there has been no physician-documented level of care
change for the resident, the discharge requirements in this Rule
apply.
Authority
G.S.
131D-2.1;
131D-2.16;
131D-4.8;
131D-4.5;
131D-21;
143B-165;
Temporary
Adoption Eff. January 1, 2000; December 1, 1999;
Eff. April 1,
2001;
Temporary Amendment Eff. July 1, 2003;
Amended
Eff. July 1, 2004.
